Robotic infrarenal paraaortic and pelvic nodal staging for endometrial cancer: feasibility and lymphatic complications

Abstract

An infrarenal robotic paraaortic lymphadenectomy is feasible in 70% of high risk endometrial cancer cases when intended (88% in non-obese patients operated by experienced surgeons), but is restricted in obese patients and by surgeon's inexperience.

Robotic-Assisted Infrarenal Para-aortic Lymphadenectomy in Gynecological Cancers

“…Moreover, the rate is in line with other studies involving PALND, which have reported corresponding complication rates of 14% to 36%. 14,15,18,24 In conclusion, a transperitoneal high PALND using the SD technique succeeds in more than 80% of the operations. The conversion rate is very low or 2.5%, and the complication rate is satisfactory, with no Clavien-Dindo grade IV or V complications.…”

“…In the previous larger studies using the same SD technique and transperitoneal approach, the median or mean numbers of para-aortic and pelvic nodes have varied between 10 and 15, and 18 and 23, respectively. 14,15 In smaller studies, fewer nodes have been harvested, indicating that a learning curve had probably not yet been established. 12,13 A transperitoneal PALND can also be performed using the double-docking technique.…”

“…The conversion rates in other studies, where SD transperitoneal approach for PALND has been used, has varied between 0% and 5%. 12,13,15 The low conversion rate in connection of robotic-assisted operations involving pelvic and para-aortic lymphadenectomies is in a clear contrast to traditional laparoscopy, where the conversion rate has been in the order of 25%. 22,23 In general, 18% of our patients had postoperative complications, and 5% had late complications.…”

Lymphedema after treatment for endometrial cancer − A review of prevalence and risk factors

“…In many of the studies the assessment of LLL was based on information retrieved from the medical records or from patient reported symptoms in the survey studies. The ISL 4-grade staging of lymphedema [26] has been used by some authors [21,24,[27][28][29], whereas others have used the National Cancer Institute Common Toxicity Criteria (NCI-CTC v2 [30]) [20,22,31,32] or the National Lymphedema Network [16] to grade the severity of lymphedema.…”

“…In four studies with only robotic surgery comprising pelvic and/or para-aortic LA [29,32,54,55], the LLL incidence was reported to be 5.2% to 21%, with a lower incidence, although not statistically significant, when the operation had been converted to LPT [54]. In all of these studies the diagnosis of LLL was based on information from the medical records, with no systematical measurements performed except in the study by Geppert et al [32] who used the NCI-CTC classification prospectively on those with symptomatic LLL but without baseline evaluation.…”